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Re: lactate (was cord pH and "birth asphyxia") From: Jason Gardosi (jason.gardosi@nottingham.ac.uk) Wed Aug 28 12:33:31 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Richard Chudacoff, MD: "Re: sharing the pain of birth" Previous message: Jason Gardosi: "Re: cord pH and "birth asphyxia"" At 04:02 28/08/96 -0500, Mats Bergstrom, MD wrote: >but these devices seem to be marketed without a manual of how to >interpret the results. And last I looked there were few references on this >to be found. True, but there are the FIGO guidelines. Plymouth (with Corning) and us (with Instrumentation Laboratories) have put algorithms into software as a decision support tool. Lactate would be easier to interpret as a single parameter for metabolic acidosis, but is not perfect (e.g. there can be false positives). >One of the co-authors, Nordstrom L, has recently presented >his thesis on the subject of scalp lactate measurements. <snip> >For theoretical reasons, their hypothesis was that lactate >would turn out superior to pH or base deficit. It didn't. Lennart sent me his thesis, and also authored the chapter on 'Fetal monitoring with lactate' with Magnus Westgren and Ingemar Ingemarsson in Bailliere's 'Intrapartum Surveillance (1996;10:2, 225-242). The way I read it, they thought cord artery lactate assessment has advantages over acid-base balance because it is simple and gives a result of the metabolic component. It would also simplify FBS, but normal values need yet to be better defined. >I would imagine that more information can never be wrong >(at least for a computer). So, a neural-network kind of >program built into the measuring device, where you entered >th Apgar data after every measurement of as many of the >possibly relevant parameters as possible, would turn out >to be useful after some 10.000 entries. > This has indeed been the theory but has yet to materialise. Neural net, fuzzy logic, chaos theory... Personally, I think the main difficulty lies with the lack of cause and effect, and the lack of association e.g. between Apgars and pH. And factors from the antenatal period which are not accounted for. Jason -- Jason Gardosi MD FRCS MRCOG OB/GYN, Queen's Medical Centre, University of Nottingham http://www.ccc.nottingham.ac.uk/~mgzobgyn/PRAM/ Next message: Richard Chudacoff, MD: "Re: sharing the pain of birth" Previous message: Jason Gardosi: "Re: cord pH and "birth asphyxia""

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